Federal Reports

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the VA Northern Indiana Health Care System, which includes a campus in Fort Wayne and Marion, and multiple outpatient clinics in Indiana. The inspection covers key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Medical Staff Privileging; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment.The leaders had worked together for nine months at the time of the OIG’s virtual review. Employee survey data indicated that leaders had created a positive workplace environment where employees felt safe bringing forth issues and concerns. Patient experience surveys highlighted opportunities to improve satisfaction in the inpatient and outpatient settings. The OIG’s review of the system’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. However, the healthcare system had disclosed 114 adverse events to patients and their families. Leaders were generally knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models and should continue to sustain and improve performance.The OIG issued 20 recommendations for improvement in five areas:(1) Medical Staff Privileging• Ongoing professional practice evaluations• Provider exit review forms• State licensing board reporting(2) Medication Management• Aberrant behavior risk assessments• Urine drug testing• Informed consent(3) Mental Health• Follow-up visits• Suicide prevention safety plans• Suicide prevention training(4) Women’s Health• Gynecological care coverage• Women veterans health committee attendance(5) High-Risk Processes• Annual risk analysis• Daily cleaning schedule• Staff training and continuing education• Competency assessments

The Office of the Inspector General conducted a review of the Commercial Energy Solutions Fuels and Hedging (F&H) organization to identify factors that could impact F&H’s organizational effectiveness. During the course of our evaluation, we identified behaviors that had a positive impact on F&H. These included relationships with team members and most management. However, we also identified a behavioral risk related to relationships with a manager in one group. In addition, we identified risks to operations that could hinder F&H’s effectiveness. These risks were related to inaccurate coal burn forecasts and interactions with business partners.

We audited costs claimed by the Utah Department of Natural Resources, Division of Wildlife Resources (Division) under grants awarded by the U.S. Fish and Wildlife Service (FWS) through the Wildlife and Sport Fish Restoration Program. We conducted this audit to determine whether the Division used grant funds and State hunting and fishing license revenue for allowable fish and wildlife activities and complied with applicable laws and regulations, FWS guidelines, and grant agreements. The audit period included claims totaling $66.1 million on 76 grants that were open during the State fiscal years that ended June 30, 2018, and June 30, 2019.We found that the State generally ensured that grant funds and hunting and fishing license revenue were used for allowable fish and wildlife activities and complied with applicable laws and regulations, FWS guidelines, and grant agreements. We noted, however, issues with subawards. We found control deficiencies with the Division’s subrecipient determination, subaward reporting, and subaward agreement elements.The FWS concurred with the six recommendations and will work with the Division to implement corrective actions.

We reviewed the actions the BLM has taken to protect its employees, volunteers, and the visiting public during the COVID-19 pandemic.

Jonathan Lasko, a resident of Hollywood, Florida, pleaded guilty in the Circuit Court ofthe Fifteenth Judicial Circuit for Palm Beach County on June 15, 2021, to charges relatedto a health care fraud scheme. Lasko, who owned addiction treatment facilities inFlorida and California, engaged in a scheme where he paid kickbacks to marketers, alsoknown as “patient brokers,” for the referral of patients to his facilities. Lasko pleadedguilty to First Degree Felony Organized Scheme to Defraud and was sentenced to fiveyears of probation. He admitted to defrauding insurance companies, includingAmtrak’s insurance administrator, Aetna, in an aggregate amount exceeding $50,000.Criminal judicial proceedings for other defendants in this case are pending.

The objective of our review was to evaluate the results of Federal Student Aid’s (FSA) process for suspending involuntary collection and refunding payments involuntarily collected on defaulted Department-held loans in response to the Coronavirus pandemic.We found that FSA suspended administrative wage garnishments and the U.S. Department of Treasury (Treasury) offsets for over 96 percent of the borrowers that FSA collected payments for within 90 days of March 13, 2020, the start of the suspension period. However, as of October 23, 2020, we found that FSA continued to receive administrative wage garnishments for 1,930 borrowers.We also found that FSA refunded most administrative wage garnishments and Treasury offsets collected from March 13, 2020, through September 30, 2020, and issued refunds for $576.65 million (99 percent) of the $582.48 million collected for the same period. FSA also refunded 1,063,984 of the 1,094,507 administrative wage garnishments and 221,436 of the 244,080 Treasury offsets within 60 days from the date the payments were received. However, we found that FSA did not reprocess refunds for $21.25 million of the $576.65 million FSA refunded that were subsequently returned to Treasury and did not refund $5.83 million (1 percent) of the $582.48 million wage garnishments and Treasury offsets collected.Finally, we found that FSA did not develop procedures to obtain and track the U.S. Department of Justice’s (Justice) progress on suspending involuntary collections and refunding payments involuntarily collected on defaulted Department-held loans from March 13, 2020, through September 30, 2020.

Delays in EPA SIP actions increase the risk that state or local air agencies are not implementing plans sufficient to achieve or maintain the NAAQS.